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<title>遗嘱网</title>
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<header><h1 class="logo"><a href="http://lastword.my" title="遗嘱网-My last word.">创建一份遗嘱</a></h1></header>
<form action="?" method="post" class="gb-form">
<fieldset>
	<legend>创建遗嘱</legend>
	<p>
		<label>标题：</label>
		<input class="txt" type="email" name="email" />
		<span class="tips">如：我的银行账户信息</span>
	</p>
	<section class="to-user">
		<label>受益人：</label>
		<input class="txt" type="text" name="toUser" />
		<fieldset class="to-user-add">
			<legend>新增受益人</legend>
			<p>
				<label>受益人真实姓名：</label>
				<input class="txt" type="text" name="toUserName"/>
			</p>
			<p>
				<label>与您的关系：</label>
				<input class="txt" type="" name="" value=""/>
				<span class="tips">家属、亲戚、朋友、同学，如：父亲</span>
			</p>
			<p>
				<label>手机：</label>
				<input class="txt" type="tel" name=""/>
			</p>
			<p>
				<label>座机：</label>
				<input class="txt" type="tel" name=""/>
			</p>
			<p>
				<label>Email：</label>
				<input class="txt" type="email" name=""/>
			</p>
			<p>
				<label>即时通：</label>
				<input class="txt" type="text" name=""/>
				<span class="tips">QQ、MSN、飞信等，格式：QQ:58989988</span>
			</p>
			<p>
				<label>联系地址：</label>
				<input class="txt" type="text" size="60" name="address"/>
				<span class="tips">邮寄地址，需要详细到门牌号。</span>
			</p>
			<p class="act">
				<button type="submit">增加</button>
			</p>
		</fieldset>
	</section>	
	<p>
		<label>遗嘱内容：</label>
		<textarea class="txt" name="conent" cols="60" rows="4" placeholder="在这里写下你想要对TA说的话，交待你想要交待的…"></textarea>
	</p>
	<p class="act">
		<button type="submit">创建</button>
	</p>
</fieldset>
</form>
<footer class="footer">&copy; 2010 <span>lastword</span>.my</footer>
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